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Discusses a form of mental decline (also called dementia). Looks at possible causes. Covers symptoms like memory loss or changes in mood or behavior. Covers treatment with medicines to help with memory and thinking problems. Offers tips for caregivers.

Alzheimer's Disease

Topic Overview

Is this topic for you?

Alzheimer's disease is the
most common cause of mental decline, or
dementia. But dementia also has many other causes. For
more information, see the topic
Dementia.

What is Alzheimer's disease?

Alzheimer's disease
damages the
brain. It causes a steady loss of memory and of how
well you can speak, think, and do your daily activities.

Alzheimer's disease gets worse over time, but how quickly this
happens varies. Some people lose the ability to do daily activities in the first few years. Others may do fairly well until much later in the disease.

Mild memory loss is common in people older than 60. It may not mean that you
have Alzheimer's disease. But if your memory is getting worse, see your doctor.
If it is Alzheimer's, treatment may help.

What causes Alzheimer's disease?

Alzheimer's
disease happens because of changes in the brain. Some of the deterioration may be related to a
loss of chemical messengers in the brain, called neurotransmitters, that allow nerve cells in the brain to communicate
properly.

People with Alzheimer's disease have two things in the brain that are not normal: amyloid plaques and neurofibrillary
tangles. Experts don't know if amyloid plaques and neurofibrillary tangles are side effects of Alzheimer's disease or part of
the cause. These plaques and tangles are not found in people who do not have the disease.

What are the symptoms?

For most people, the first
symptom of Alzheimer's disease is memory loss. Often the person who has a
memory problem doesn't notice it, but family and friends do. But the person
with the disease may also know that something is wrong.

The symptoms of Alzheimer's get worse slowly over time. You may:

Have trouble making decisions.

Be confused about what time and day it is.

Get lost in places you know well.

Have trouble learning and remembering new
information.

Have trouble finding the right words to say what you want to say.

Have more trouble doing daily tasks like
cooking a meal or paying bills.

A person who gets these symptoms over a few hours or days or whose symptoms
suddenly get worse needs to see a doctor right away, because there may be
another problem.

How is Alzheimer's disease diagnosed?

Your doctor will ask about your past health and do a physical
exam. He or she may ask you to do some simple things that test your memory and
other mental skills. Your doctor may also check how well you can do daily
tasks.

The exam usually includes blood tests to look for another
cause of your problems. You may have tests such as
CT scans and
MRI scans, which look at your brain. By themselves,
these tests can't show for sure whether you have Alzheimer's.

How is it treated?

There is no cure for
Alzheimer's disease. But there are medicines that may slow symptoms down for a while
and make the disease easier to live with. These medicines may not work for everyone or have a big
effect. But most experts think they are worth a try.

As the
disease gets worse, you may get
depressed or angry and upset. The doctor may also
prescribe medicines to help with these problems.

How can you help your loved one with Alzheimer's disease?

If you are or will be taking care of a loved one with
Alzheimer's, start learning what you can expect. This can help you make the
most of the person's abilities as they change. And it can help you deal with
new problems as they arise.

Your loved one will need more and
more care as the disease gets worse. You may be able to give this care at home. Or
you may want to think about using assisted living or a nursing home.

Ask your doctor about
local resources such as support groups or other groups that can help as you
care for your loved one. You can also search the Internet for online support
groups. Help is available.

Cause

Alzheimer's disease causes loss of brain cells in areas of the brain. Some of the deterioration may be related to a loss
of chemical messengers in the brain, called neurotransmitters, that
allow nerve cells in the brain to communicate properly.

People with Alzheimer's disease have two things in the brain that are not normal: amyloid plaques and neurofibrillary tangles.

Amyloid plaques are clumps of a protein called beta amyloid. This plaque builds up around the cells in the brain that communicate with each other.

Neurofibrillary tangles are made from a protein called tau. Normally, the tau protein helps cells communicate in the brain. In Alzheimer's disease, the tau protein twists and tangles. The tangles clump together, and some nerve cells die, which makes communication in the brain much harder.

As brain cells die, it shrinks. The damage to the brain eventually causes problems with memory, intelligence, judgment, language, and behavior.

Experts don't know if
amyloid plaques and neurofibrillary tangles are side effects of Alzheimer's disease or part of the cause. These plaques and tangles are not found in people who do not have the disease.

Symptoms

Memory loss is usually the first sign of
Alzheimer's disease. Having some
short-term memory loss in your 60s and 70s is common, but this doesn't mean it's Alzheimer's disease.

Compare these examples of normal memory problems and the types of memory problems that may be caused by Alzheimer's disease.

Symptoms of normal forgetfulness versus Alzheimer's disease

In normal forgetfulness, the person may forget:

In Alzheimer's disease, the person may forget:

Parts of an experience.

An entire experience.

Where the
car is parked.

What the car looks like.

A person's
name, but remember it later.

Ever having known a particular person.

Alzheimer's disease also causes changes in thinking,
behavior, and personality. Close family members and friends may first notice these symptoms, although the person may also realize that something is
wrong.

Following are some of the symptoms of the different stages of Alzheimer's disease. They vary as the disease progresses. Talk to your doctor if a friend or family member has any of the signs.

Mild Alzheimer's disease

Usually, a person with mild Alzheimer's disease:

Avoids new and unfamiliar situations.

Has delayed reactions and slowed learning
ability.

Begins speaking more slowly than in the past.

Starts using poor judgment and making inappropriate
decisions.

May have mood swings and become depressed, irritable, or
restless.

These symptoms often are more obvious when the person is
in a new and unfamiliar place or situation.

Some people have memory loss called mild cognitive impairment. People with this condition are at risk for Alzheimer's disease or another type of dementia. But not all people with mild cognitive impairment progress to dementia.

Moderate Alzheimer's disease

With moderate Alzheimer's disease, a person
typically:

Has problems recognizing close friends and
family.

Becomes more restless, especially in late afternoon
and at night. This is called sundowning.

Has problems reading,
writing, and dealing with numbers.

Has trouble dressing.

Cannot work simple appliances such as a microwave.

Severe Alzheimer's disease

With severe Alzheimer's disease, a person
usually:

Can no longer remember how to bathe, eat,
dress, or go to the bathroom independently.

No longer knows when to chew and swallow.

Has
trouble with balance or walking and may fall frequently.

Becomes more confused in the evening (sundowning) and has trouble sleeping.

Cannot communicate using words.

Loses bowel or bladder control (incontinence).

Other conditions with similar symptoms

Early in the disease, Alzheimer's usually doesn't affect a
person's fine motor skills (such as the ability to button or unbutton clothes
or use utensils) or sense of touch. So a person who develops motor symptoms (such
as weakness or shaking hands) or sensory symptoms (such as numbness) probably
has a condition other than Alzheimer's disease. Conditions such as
Parkinson's disease, for instance, may cause motor
symptoms along with dementia.

Other conditions with symptoms
similar to those of Alzheimer's disease may include:

Other problems such as kidney
and liver disease and some infections such as
HIV (human immunodeficiency virus).

What Happens

Researchers have discovered
changes that take place in the brains of people who have
Alzheimer's disease. These brain changes may cause the memory loss and decline
in other mental abilities that occur with Alzheimer's disease. It's not fully
understood why these brain changes occur in some people but not in
others.

Alzheimer's disease gets worse over time, but the
course of the disease varies from person to person. Some people may still be
able to function relatively well until late in the course of the disease.
Others may lose the ability to do everyday activities very early on.

The disease tends to get worse gradually. It
usually starts with mild memory loss. It progresses to severe mental and
functional problems and eventual death.

Symptoms sometimes are
described as occurring in early, middle, and late phases. It's hard to
predict how long each phase will last.

The average amount of time a
person lives after developing symptoms of Alzheimer's disease is 8 to 10
years.

A person with severe dementia becomes more vulnerable to other illnesses, such as pneumonia.

What Increases Your Risk

Certain things make getting a disease more likely. These are called risk factors. Risk factors for Alzheimer's disease include:

Getting older. This is the main risk factor. People rarely have dementia before age
60.

A
family history of Alzheimer's disease, especially if
one or more of your parents or siblings has the disease.

Injuries to the brain, especially more than one injury that caused you to pass out (such as a concussion from a fall, car accident, or playing a sport.)

When To Call a Doctor

Alzheimer's disease tends to develop slowly over time. If confusion and other
changes in mental abilities come on suddenly, within hours or days, the problem
may be
delirium. Delirium needs treatment right away.

Seek care right away if:

Symptoms such as a shortened attention span,
memory problems, or seeing or hearing things that aren't really there (hallucinations) develop suddenly over hours to days.

A person who has
Alzheimer's disease has a sudden, significant change in normal behavior or if
symptoms suddenly become worse.

Call your doctor to schedule an appointment if:

Symptoms such as a shortened attention span,
memory problems, or false beliefs (delusions)
develop gradually over a few weeks or months.

Memory loss and
other symptoms begin to interfere with the person's work or social life or
could cause injury or harm to the person.

You need help caring
for a person with Alzheimer's disease.

Watchful waiting

If memory loss isn't rapidly becoming worse or
interfering with work, social life, or the ability to function, it may be
normal age-related memory loss. Talk to your doctor if you are concerned about
memory loss.

Who to see

The following health professionals can evaluate
symptoms of memory loss or confusion:

Exams and Tests

Alzheimer's disease is diagnosed after other
conditions are ruled out. Your doctor will use a variety of tests to do this.

It usually
is helpful to have a family member or someone in close contact with the person
present at the appointment. A family member may be able to provide the best
information about how a person's day-to-day functioning, memory, and
personality have changed.

Initial tests

The doctor will use a medical history and physical exam to help find out if a physical problem may be causing the person's
symptoms. Sometimes another problem can cause the same symptoms as Alzheimer's.

Lab tests

Lab tests may be done to rule out other possible causes of a person's
symptoms, such as levels of certain minerals or chemicals in the blood, liver disease, abnormal thyroid levels, or nutritional
problems, such as folate or vitamin B12 deficiencies. Treatment for these
conditions may slow or reverse mental decline.

Regular checkups. The doctor will check the person's response to medicine, look for new problems, see how symptoms are changing, and provide continuing education to the family. Treatment decisions often need to be revisited as the disease progresses. A person with Alzheimer's should see the doctor every 6 months, or sooner if a problem arises.

Helping the person remain independent and manage daily life as long as possible.

A plan for the caregiver. Most people with Alzheimer's disease can
be cared for at home by family or friends, at least until the disease becomes
severe.

See Home Treatment to learn more about helping the person remain independent, making the most of the person's abilities, and dealing with new problems as they arise.

What to think about

An important part of treatment is
finding and treating other medical problems the person may have.

Depression occurs in nearly half of people with
Alzheimer's disease, especially those in the early stage of the disease. Helping them get treatment for depression can help them to do better with the abilities they still have.

Hearing and vision loss,
thyroid problems, kidney problems, and other
conditions are common in older adults and may make Alzheimer's worse. Treating these problems can improve quality of life and ease the
burden on the caregiver.

Prevention

At this time, there is no known way to
prevent
Alzheimer's disease. But there are things that may make it less likely.

Adults who are physically active may be less likely than adults who aren't physically
active to get
Alzheimer's disease or another type of dementia. Moderate activity is safe for most people, but it's always a good idea to talk to your doctor before starting an exercise
program.

Older adults who stay
mentally active may be at lower risk for Alzheimer's
disease. Reading, playing cards and other games, working
crossword puzzles, and
even watching television or listening to the radio may help them avoid
symptoms of the disease. So can going out and remaining as socially active as possible. Although this "use it or lose it" approach hasn't been proved, no harm can come from regularly putting the brain to work.

People who eat more fruits and
vegetables, high-fiber foods, fish, and omega-3 rich oils (sometimes known as
the Mediterranean diet) and who eat less red meat and dairy may have some
protection against dementia.

Home Treatment

Most people who have
Alzheimer's disease are cared for at home by family members and friends. Taking
care of someone with the disease can be physically and emotionally
draining, but there are ways to make it easier.

Home treatment involves teamwork among health professionals and caregivers to create a safe and comfortable environment and to make tasks of daily living as easy as possible. Some people with early or mild Alzheimer's disease can be involved in planning for the future and organizing the home and daily tasks.

One of the keys to successful
home care is educating yourself. You can do a lot to make the most of the
person's remaining abilities, manage the problems that develop, and improve the
quality of his or her life as well as your own. Also remember that caregiving
can be a positive experience for you and the person you are caring for.

Caregivers should remember to
seek support from other family and friends. Groups
such as the Alzheimer's Association and the Dementia Advocacy and Support
Network can provide not only educational materials but also information on
support groups and services. For more
information, see the topic
Caregiver Tips.

Plan for the future

As
Alzheimer's disease progresses, you have decisions to make about medical care and legal issues.

A nursing home or assisted living. Providing care at home
usually becomes more and more challenging. The decision to place a family
member in a nursing home or other facility can be a very difficult one. But
sometimes nursing home placement is the best choice.

Palliative care. This is a kind of care for
people who have a serious illness. It's different from care to cure your illness. Its goal is to improve quality of life—not only in the body but
also in the mind and spirit. Talk to
your doctor if you are interested in this type of care. See the topic Palliative Care.

End-of-life care. You may want to discuss health care and
other legal issues that may arise near the end of life. An advance directive or
living will lets people with the disease give others their health care instructions. To learn more, see the topic
Care at the End of Life.

Medications

There are no medicines that
can prevent or cure
Alzheimer's disease. Medicine may help some people function better by temporarily
reducing memory loss and thinking problems. Other medicines may be needed to manage behaviors or symptoms that are causing strain for the person
who has Alzheimer's disease and/or for his or her caregivers.

Medicines for memory problems

Cholinesterase inhibitors treat symptoms of mental decline in
people who have mild to moderate Alzheimer's disease. They include
donepezil,
galantamine, and rivastigmine. Donepezil can be used to help those who have severe Alzheimer's disease.

Because these medicines work differently, they are sometimes used together (for example, memantine and donepezil).

These medicines may temporarily help improve memory and daily
functioning in some people who have Alzheimer's disease. The improvement varies
from person to person. These medicines don't prevent the disease from getting
worse. But they may slow down symptoms of mental decline.

The main
decision about using these usually isn't
whether to try a medicine but when to begin and stop treatment.
Treatment can be started as soon as Alzheimer's disease is diagnosed.
If the medicines are effective, they are
continued until the side effects outweigh the benefits or until the person no
longer responds to the medicines.

Medicines for behavior problems

Other medicines may be tried to treat anxiety,
agitated or hostile behavior, sleep problems, frightening or disruptive false
beliefs (delusions), suspicion of others (paranoia), or hallucinations (seeing
or hearing things that aren't there).

Before deciding
to use medicine for behavior problems, try to see what is causing
the behavior. If you know the cause, you may be able to find better ways of dealing with that behavior. You may be able to avoid treatment with
medicine and the side effects and costs that come with it.

Medicines generally are
used only for behavior problems when other treatments have failed. They may be needed if:

A behavior is severely disruptive or harmful
to the person or to others.

Efforts to manage or reduce disruptive
behavior by making changes in the person's environment or routines have
failed.

The behavior is making the situation intolerable for the
caregiver.

The person has trouble telling the difference between
what is and is not real (psychosis). Psychosis means the person has false
beliefs (delusions) or hears or sees things that aren't
there (hallucinations).

What to think about

Close monitoring and regular
reevaluation of the person who has Alzheimer's disease are very important during
treatment with medicine. As the disease progresses and symptoms change, the
person's medicine needs often change. If you are a caregiver for someone with
Alzheimer's disease, be alert for adverse drug reactions or side effects that
further impair the person's ability to function.

Other Treatment

Other therapies, such as light therapy,
aromatherapy, and exercise, may help reduce behaviors such as agitation. But they should only be done with supervision.

Other treatment choices

Ginkgo biloba is one of several dietary supplements promoted to improve or preserve memory. The effectiveness of these products is unclear.

Aromatherapy oils, such as lavender, rosemary, and lemon, may reduce agitation in some people who have dementia.

Light therapy is often used to relieve depression. It may help reduce depression,
agitation, and sleeplessness associated with Alzheimer's disease.

Exercise, such as walking or swimming, can also relieve symptoms of depression
associated with Alzheimer's disease. Exercise is most effective when it is
combined with teaching caregivers how to work through behavioral problems with
the person who has Alzheimer's disease.

Another way a caregiver can try to reduce agitation in a person who has Alzheimer's disease is to
play soothing music during meals
and when the caregiver is helping with bathing.

What to think about

Other treatments for Alzheimer's disease need further study. Their effectiveness and possible side effects aren't yet
fully known. Talk to your doctor before you decide to try any
herbal therapies, supplements, or nonprescription
treatments.

Related Information

References

Other Works Consulted

Albert MS, et al. (2011). The diagnosis of mild cognitive impairment due to Alzheimer's disease: Recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimer's and Dementia, 7 (3): 270–279.

American Psychiatric Association (2007). Practice Guideline for the Treatment of Patients With Alzheimer's Disease and Other Dementias. Arlington, VA: American Psychiatric Association. Available online: http://psychiatryonline.org/guidelines.aspx.

McKhann GM, et al. (2011). The diagnosis of dementia due to Alzheimer's disease: Recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease. Alzheimer's and Dementia, 7 (3): 263–269.

Qaseem A, et al. (2008). Current pharmacologic treatment of dementia: A clinical practice guideline from the American College of Physicians and the American Academy of Family Physicians. Annals of Internal Medicine, 148: 370–378.

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